2023-07-31 19:19:35

胸膜炎最常見的癥狀為胸痛。胸痛常突然出現，程度差異較大，可為不明確的不適或嚴重的刺痛，可僅在患者深呼吸或咳嗽時出現，亦可持續存在并因深呼吸或咳嗽而加劇。胸痛為壁層胸膜的炎癥所致，通常出現于正對炎癥部位的胸壁。亦可表現為腹部、頸部或肩部的牽涉痛 。胸膜炎
由(you)于深呼(hu)吸(xi)可致疼(teng)痛(tong)，故常引起呼(hu)吸(xi)淺快，患側(ce)(ce)肌肉運動較對側(ce)(ce)為(wei)弱(ruo)。如果發生(sheng)大量積聚，可致兩層胸(xiong)(xiong)膜相互分離(li)，則(ze)胸(xiong)(xiong)痛(tong)可消(xiao)失。大量胸(xiong)(xiong)腔積液可致呼(hu)吸(xi)時單(dan)側(ce)(ce)或雙(shuang)側(ce)(ce)肺(fei)擴張受限，發生(sheng)呼(hu)吸(xi)困難(nan)。 這個胸(xiong)(xiong)膜炎(yan)的(de)治(zhi)療(liao)是(shi)(shi)很主要的(de)，只有能正確(que)的(de)辯證治(zhi)療(liao)，對這下藥(yao)，才能使患者早日康復的(de)。像椒目葶(ting)藶湯就是(shi)(shi)不錯的(de)辦法(fa)的(de)

2023-07-31 19:19:35

目錄1拼音2英文參考3概述4疾病名稱5英文名稱6分類7ICD號8流行病學9結核性胸膜炎的病因10發病機制11結核性胸膜炎的臨床表現12結核性胸膜炎的并發癥13實驗室檢查14輔助檢查 14.1胸膜活檢14.2X線檢查 14.2.1葉間積液14.2.2肺下積液14.2.3包裹性積液14.2.4縱隔積液 14.3超聲波檢查 15結核性胸膜炎的診斷16鑒別診斷 16.1細菌性肺炎16.2類肺炎性胸腔積液16.3惡性胸腔積液 17結核性胸膜炎的治療 17.1一般治療17.2胸腔穿刺抽液17.3抗結核藥物治療 18預后19結核性胸膜炎的預防 19.1控制傳染源，減少傳染機會19.2普及卡介苗接種19.3預防性化療 20相關藥品21相關檢查附：1結核性胸膜炎相關藥物 1拼音

jié hé xìng xiōng mó yán

2英文參考

tuberculous pleurisy

3概述

當肺部炎癥累(lei)及(ji)胸(xiong)(xiong)膜(mo)時(shi)引起的(de)胸(xiong)(xiong)膜(mo)炎癥稱為胸(xiong)(xiong)膜(mo)炎。在某些情況(kuang)下(xia)胸(xiong)(xiong)膜(mo)炎是通(tong)過血(xue)行感染(ran)而致病的(de)，也有部分(fen)是與機體的(de)變(bian)態反應有關。因機體反應性(xing)不同，臨床可出現(xian)干性(xing)和滲出性(xing)胸(xiong)(xiong)膜(mo)炎兩種(zhong)狀況(kuang)。

胸(xiong)(xiong)(xiong)膜炎(yan)(yan)(yan)(yan)可由(you)(you)一般的(de)細(xi)菌感染(ran)(ran)(ran)或特(te)殊的(de)細(xi)菌感染(ran)(ran)(ran)引(yin)(yin)起，常常伴有胸(xiong)(xiong)(xiong)腔(qiang)(qiang)(qiang)積(ji)(ji)(ji)液。由(you)(you)于肺(fei)炎(yan)(yan)(yan)(yan)、肺(fei)膿腫和支氣管(guan)擴張感染(ran)(ran)(ran)引(yin)(yin)起的(de)胸(xiong)(xiong)(xiong)腔(qiang)(qiang)(qiang)積(ji)(ji)(ji)液稱為類(lei)肺(fei)炎(yan)(yan)(yan)(yan)性(xing)胸(xiong)(xiong)(xiong)腔(qiang)(qiang)(qiang)積(ji)(ji)(ji)液（parapneumoniceffusion）；需行(xing)胸(xiong)(xiong)(xiong)腔(qiang)(qiang)(qiang)內(nei)插管(guan)引(yin)(yin)流治療(liao)的(de)類(lei)肺(fei)炎(yan)(yan)(yan)(yan)性(xing)胸(xiong)(xiong)(xiong)腔(qiang)(qiang)(qiang)積(ji)(ji)(ji)液稱為復雜性(xing)類(lei)肺(fei)炎(yan)(yan)(yan)(yan)性(xing)胸(xiong)(xiong)(xiong)腔(qiang)(qiang)(qiang)積(ji)(ji)(ji)液 （plicated parapneumonic effusion）。胸(xiong)(xiong)(xiong)膜炎(yan)(yan)(yan)(yan)常為單側(ce)，雙側(ce)者常提示為血行(xing)播(bo)散性(xing)結(jie)核所致。積(ji)(ji)(ji)液少(shao)量(liang)至中等量(liang)，由(you)(you)于結(jie)核性(xing)胸(xiong)(xiong)(xiong)膜炎(yan)(yan)(yan)(yan)滲(shen)液中的(de)蛋白(bai)質較高(gao)，易引(yin)(yin)起胸(xiong)(xiong)(xiong)膜粘連及肥厚。

結(jie)核(he)性(xing)胸(xiong)(xiong)膜(mo)炎須(xu)與細(xi)菌性(xing)肺炎和胸(xiong)(xiong)膜(mo)炎，以及惡性(xing)胸(xiong)(xiong)腔積液進行鑒別(bie)。

結核(he)性胸(xiong)(xiong)膜(mo)炎的(de)治(zhi)療(liao)(liao)(liao)包(bao)括一般治(zhi)療(liao)(liao)(liao)、抽取胸(xiong)(xiong)液和抗結核(he)治(zhi)療(liao)(liao)(liao)。其化(hua)療(liao)(liao)(liao)原則與化(hua)療(liao)(liao)(liao)方(fang)法和活(huo)動性結核(he)相同(tong)。對(dui)結核(he)性胸(xiong)(xiong)膜(mo)炎進(jin)行及時(shi)正確的(de)治(zhi)療(liao)(liao)(liao)，預后多(duo)良好，如病程遷延常至胸(xiong)(xiong)膜(mo)粘連、包(bao)裹，造(zao)成營養不良等，影響預后。

4疾病名稱

結核性胸膜炎

5英文名稱

tuberculous pleurisy

6分類

呼(hu)吸科 > 胸膜疾病 > 胸膜炎

7ICD號

A15.9

8流行病學

結(jie)(jie)核(he)性(xing)胸(xiong)(xiong)(xiong)膜(mo)(mo)炎可發生(sheng)(sheng)于(yu)任何(he)年(nian)(nian)齡，于(yu)青壯(zhuang)年(nian)(nian)時期最多見。在美(mei)國，類肺(fei)炎性(xing)胸(xiong)(xiong)(xiong)腔積液(ye)為胸(xiong)(xiong)(xiong)膜(mo)(mo)炎的(de)主(zhu)要(yao)病因，結(jie)(jie)核(he)性(xing)胸(xiong)(xiong)(xiong)膜(mo)(mo)炎每(mei)年(nian)(nian)僅1000例(li)左右(you)。艾滋病患(huan)者也(ye)常發生(sheng)(sheng)結(jie)(jie)核(he)感染(ran)，但發生(sheng)(sheng)胸(xiong)(xiong)(xiong)膜(mo)(mo)炎并(bing)不多見，主(zhu)要(yao)是其免疫(yi)系統(tong)受(shou)損所(suo)致。在我國，結(jie)(jie)核(he)性(xing)胸(xiong)(xiong)(xiong)膜(mo)(mo)炎是最常見的(de)一種胸(xiong)(xiong)(xiong)膜(mo)(mo)炎，約占(zhan)滲出性(xing)胸(xiong)(xiong)(xiong)腔積液(ye)的(de)54.8%。大約每(mei)30例(li)肺(fei)結(jie)(jie)核(he)中有1例(li)是結(jie)(jie)核(he)性(xing)胸(xiong)(xiong)(xiong)膜(mo)(mo)炎，國內報道結(jie)(jie)核(he)性(xing)胸(xiong)(xiong)(xiong)膜(mo)(mo)炎占(zhan)肺(fei)結(jie)(jie)核(he)4.7%～17.6%。

9結核性胸膜炎的病因

原(yuan)發(fa)性結(jie)核病是結(jie)核桿(gan)菌(jun)(jun)(jun)首次侵入機(ji)體(ti)所引(yin)(yin)起(qi)的(de)(de)疾病。結(jie)核桿(gan)菌(jun)(jun)(jun)有(you)4型：人型、牛(niu)型、鳥型和鼠型。而(er)對人體(ti)有(you)致病力者為人型結(jie)核桿(gan)菌(jun)(jun)(jun)和牛(niu)型結(jie)核桿(gan)菌(jun)(jun)(jun)。我國小兒結(jie)核病大多數由人型結(jie)核菌(jun)(jun)(jun)所引(yin)(yin)起(qi)。結(jie)核桿(gan)菌(jun)(jun)(jun)的(de)(de)抵抗力較(jiao)(jiao)強，除(chu)有(you)耐酸、耐堿、耐酒精(jing)的(de)(de)特性外(wai)，對于(yu)冷、熱、干燥、光(guang)線(xian)以及化學物質等(deng)都有(you)較(jiao)(jiao)強的(de)(de)耐受(shou)力。濕熱對結(jie)核菌(jun)(jun)(jun)的(de)(de)殺菌(jun)(jun)(jun)力較(jiao)(jiao)強，在(zai)65℃ 30min，70℃ 10min，80℃ 5min即可(ke)殺死。干熱殺菌(jun)(jun)(jun)力較(jiao)(jiao)差，干熱100℃需(xu)20min以上才能(neng)殺死，因此干熱殺菌(jun)(jun)(jun)，溫度需(xu)高、時間需(xu)長。痰(tan)內(nei)的(de)(de)結(jie)核菌(jun)(jun)(jun)在(zai)直接太陽(yang)光(guang)下2h內(nei)被殺死，而(er)紫(zi)外(wai)線(xian)僅需(xu)10min。相反在(zai)陰暗處可(ke)存活數月之久。痰(tan)液(ye)內(nei)的(de)(de)結(jie)核菌(jun)(jun)(jun)如用5%的(de)(de)石炭酸（苯(ben)酚）或20%漂(piao)白(bai)粉液(ye)消(xiao)毒，則(ze)需(xu)24h方能(neng)生效(xiao)。

10發病機制

引起結核性胸(xiong)膜炎的途(tu)徑有：

①肺門淋巴結核的(de)細菌(jun)經(jing)淋巴管(guan)逆流(liu)至胸膜(mo)；

②鄰近(jin)胸膜的(de)肺(fei)結核病(bing)灶破潰(kui)，使結核桿菌或結核感染(ran)的(de)產物直接進入胸膜腔內；

③急性(xing)或(huo)亞(ya)急性(xing)血行播散性(xing)結核引(yin)致(zhi)胸膜(mo)炎；

④機體的變(bian)應(ying)性較高(gao)，胸膜對(dui)結核毒素(su)出(chu)現高(gao)度反應(ying)引起滲出(chu)；

⑤胸(xiong)椎結核(he)和(he)肋(lei)骨結核(he)向胸(xiong)膜腔(qiang)潰(kui)破。

以往認為結(jie)(jie)(jie)核(he)性(xing)胸腔積液(ye)系胸膜對結(jie)(jie)(jie)核(he)毒(du)素過敏的觀點(dian)是片面的，因為針式胸膜活(huo)檢(jian)或胸腔鏡活(huo)檢(jian)已(yi)經證實80%結(jie)(jie)(jie)核(he)性(xing)胸膜炎(yan)壁層胸膜有典型的結(jie)(jie)(jie)核(he)病(bing)理(li)改變。因此，結(jie)(jie)(jie)核(he)桿(gan)菌直接感染胸膜是結(jie)(jie)(jie)核(he)性(xing)胸膜炎(yan)的主要(yao)發(fa)病(bing)機(ji)制。

早期胸(xiong)(xiong)(xiong)膜充血(xue)，白細胞浸潤(run)，隨(sui)后為淋巴細胞浸潤(run)占優勢。胸(xiong)(xiong)(xiong)膜表面(mian)有纖維素性滲出，繼而出現漿液性滲出。由于大(da)量纖維蛋白沉著于胸(xiong)(xiong)(xiong)膜，可形成(cheng)包裹性胸(xiong)(xiong)(xiong)腔積液或廣泛胸(xiong)(xiong)(xiong)膜增(zeng)厚。胸(xiong)(xiong)(xiong)膜常(chang)有結核結節形成(cheng)。

11結核性胸膜炎的臨床表現

大多數(shu)結核性胸(xiong)(xiong)膜(mo)炎是急性起病(bing)。其癥(zheng)狀主要(yao)表(biao)(biao)現為結核的(de)全身中毒(du)癥(zheng)狀和(he)胸(xiong)(xiong)腔積(ji)液(ye)(ye)(ye)所致的(de)局部癥(zheng)狀。結核中毒(du)癥(zheng)狀主要(yao)表(biao)(biao)現為發(fa)熱(re)、畏寒、出汗、乏(fa)力、食欲不振、盜(dao)汗。局部癥(zheng)狀有(you)胸(xiong)(xiong)痛(tong)(tong)、干咳和(he)呼(hu)(hu)吸(xi)(xi)困難(nan)。胸(xiong)(xiong)痛(tong)(tong)多位于胸(xiong)(xiong)廓呼(hu)(hu)吸(xi)(xi)運動幅(fu)度(du)最大的(de)腋前線(xian)(xian)或腋后線(xian)(xian)下方，呈銳痛(tong)(tong)，隨深呼(hu)(hu)吸(xi)(xi)或咳嗽而加重(zhong)。由(you)于胸(xiong)(xiong)腔內積(ji)液(ye)(ye)(ye)逐漸增多，幾天后胸(xiong)(xiong)痛(tong)(tong)逐漸減輕或消失。積(ji)液(ye)(ye)(ye)對(dui)胸(xiong)(xiong)膜(mo)的(de) *** 可引起反(fan)射性干咳， *** 轉動時更(geng)為明顯(xian)。積(ji)液(ye)(ye)(ye)量少時僅有(you)胸(xiong)(xiong)悶(men)、氣促，大量積(ji)液(ye)(ye)(ye)壓迫(po)肺(fei)、心(xin)和(he)縱隔，則可發(fa)生(sheng)呼(hu)(hu)吸(xi)(xi)困難(nan)。積(ji)液(ye)(ye)(ye)產生(sheng)和(he)聚(ju)集越(yue)快(kuai)、越(yue)多，呼(hu)(hu)吸(xi)(xi)困難(nan)越(yue)明顯(xian)，甚至可有(you)端坐(zuo)呼(hu)(hu)吸(xi)(xi)和(he)發(fa)紺。

體征(zheng)與積(ji)(ji)液(ye)量和積(ji)(ji)聚部位有(you)(you)關。積(ji)(ji)液(ye)量少(shao)者(zhe)或(huo)(huo)葉間(jian)胸(xiong)(xiong)膜積(ji)(ji)液(ye)的胸(xiong)(xiong)部體征(zheng)不明顯，或(huo)(huo)早(zao)期可(ke)聽(ting)到(dao)胸(xiong)(xiong)膜摩(mo)擦音(yin)(yin)(yin)。積(ji)(ji)液(ye)中等量以上者(zhe)患(huan)側(ce)(ce)(ce)胸(xiong)(xiong)廓(kuo)稍凸，肋(lei)間(jian)隙(xi)飽滿(man)，呼(hu)吸運動受(shou)限。氣管(guan)、縱隔(ge)和心臟向健側(ce)(ce)(ce)移位。患(huan)側(ce)(ce)(ce)語音(yin)(yin)(yin)震(zhen)顫減弱(ruo)(ruo)(ruo)或(huo)(huo)消失，叩診濁(zhuo)音(yin)(yin)(yin)或(huo)(huo)實音(yin)(yin)(yin)。聽(ting)診呼(hu)吸音(yin)(yin)(yin)減弱(ruo)(ruo)(ruo)或(huo)(huo)消失，語音(yin)(yin)(yin)傳導減弱(ruo)(ruo)(ruo)。由于(yu)接近(jin)胸(xiong)(xiong)腔(qiang)積(ji)(ji)液(ye)上界的肺(fei)被壓縮，在(zai)該(gai)部聽(ting)診時可(ke)發現呼(hu)吸音(yin)(yin)(yin)不減弱(ruo)(ruo)(ruo)反而增(zeng)強(qiang)。如(ru)有(you)(you)胸(xiong)(xiong)膜粘連與胸(xiong)(xiong)膜增(zeng)厚時，可(ke)見患(huan)側(ce)(ce)(ce)胸(xiong)(xiong)廓(kuo)下陷，肋(lei)間(jian)隙(xi)變窄，呼(hu)吸運動受(shou)限，語音(yin)(yin)(yin)震(zhen)顫增(zeng)強(qiang)，叩診濁(zhuo)音(yin)(yin)(yin)，呼(hu)吸音(yin)(yin)(yin)減弱(ruo)(ruo)(ruo)。

干性(xing)胸(xiong)膜炎患側呼吸運動受限(xian)，局(ju)部有壓痛，可(ke)觸(chu)及(ji)胸(xiong)膜摩(mo)擦(ca)感，聽診有胸(xiong)膜摩(mo)擦(ca)音(yin)。

滲出性(xing)胸(xiong)膜炎胸(xiong)腔積液(ye)(ye)(ye)較(jiao)多時(shi)，患側胸(xiong)廓(kuo)飽滿，肋間隙增寬，呼(hu)吸動度、語顫(zhan)減弱，氣管(guan)和心臟向健(jian)側移位，液(ye)(ye)(ye)平面以下扣診(zhen)濁(zhuo)音(yin)(yin)(yin)，呼(hu)吸音(yin)(yin)(yin)減弱或消(xiao)失，液(ye)(ye)(ye)平面上方(fang)可有(you)支氣管(guan)肺泡(pao)呼(hu)吸音(yin)(yin)(yin)，偶有(you)小水泡(pao)音(yin)(yin)(yin)。右側胸(xiong)腔積液(ye)(ye)(ye)時(shi)肝濁(zhuo)音(yin)(yin)(yin)界消(xiao)失。如有(you)胸(xiong)膜粘連肥厚(hou)局部胸(xiong)廓(kuo)下陷，呼(hu)吸運動受(shou)限(xian)扣診(zhen)濁(zhuo)音(yin)(yin)(yin)，呼(hu)吸音(yin)(yin)(yin)減弱。

12結核性胸膜炎的并發癥

結核性胸膜炎(yan)可形成葉間胸膜炎(yan)、縱隔胸膜炎(yan)，包裹性積液和肺底(di)積液等。

13實驗室檢查

結核性(xing)胸膜炎初期，血中白細胞(bao)(bao)總數(shu)(shu)可增高或(huo)正常，中性(xing)粒細胞(bao)(bao)占優勢，爾后白細胞(bao)(bao)計(ji)數(shu)(shu)正常，并轉為淋巴細胞(bao)(bao)為主(zhu)。紅(hong)細胞(bao)(bao)沉降率增快。

胸(xiong)(xiong)液(ye)外觀多(duo)呈(cheng)草黃色(se)，透明或微濁，或呈(cheng)毛玻璃狀。少(shao)數(shu)胸(xiong)(xiong)液(ye)可(ke)呈(cheng)黃色(se)、深黃色(se)、漿液(ye)血(xue)性(xing)(xing)乃至(zhi)血(xue)性(xing)(xing)。比重(zhong)1.018以上，Rivalta試驗(yan)陽(yang)性(xing)(xing)。pH約7.00～7.30。有核(he)細(xi)(xi)胞(bao)數(shu)（0.1～2.0）×109/L，急(ji)性(xing)(xing)期以中性(xing)(xing)粒細(xi)(xi)胞(bao)占優勢，而(er)后以淋巴細(xi)(xi)胞(bao)占優勢。蛋白(bai)定(ding)量(liang)30g/L以上，如(ru)大于50g/L，更支持(chi)結(jie)核(he)性(xing)(xing)胸(xiong)(xiong)膜炎(yan)的(de)(de)診(zhen)斷。葡萄糖含(han)量(liang)＜3.4mmol/L，乳(ru)酸(suan)脫氫(qing)酶（LDH）＞200U/L，腺苷脫氨(an)酶（ADA）＞45U/L，干擾素γ＞3.7μ/ml。癌胚抗原(yuan) （CEA）＜20μg/L，流式細(xi)(xi)胞(bao)術細(xi)(xi)胞(bao)呈(cheng)多(duo)倍體(ti)(ti)。目前有報道測定(ding)胸(xiong)(xiong)腔積(ji)液(ye)的(de)(de)結(jie)核(he)性(xing)(xing)抗原(yuan)和抗體(ti)(ti)，雖然結(jie)核(he)性(xing)(xing)胸(xiong)(xiong)膜炎(yan)者其胸(xiong)(xiong)腔積(ji)液(ye)的(de)(de)濃度明顯(xian)高(gao)于非結(jie)核(he)性(xing)(xing)者，但特(te)異性(xing)(xing)不高(gao)，限制其臨床(chuang)應用。胸(xiong)(xiong)腔積(ji)液(ye)的(de)(de)結(jie)核(he)桿菌陽(yang)性(xing)(xing)率低于25%，如(ru)采(cai)用胸(xiong)(xiong)腔積(ji)液(ye)離心沉淀(dian)后涂(tu)片、胸(xiong)(xiong)腔積(ji)液(ye)或胸(xiong)(xiong)膜組織培養、聚(ju)合(he)酶鏈反應（PCR）等，可(ke)以提(ti)高(gao)陽(yang)性(xing)(xing)率。胸(xiong)(xiong)腔積(ji)液(ye)間皮細(xi)(xi)胞(bao)計數(shu)＜5%。

14輔助檢查14.1胸膜活檢

針刺胸(xiong)(xiong)(xiong)膜(mo)(mo)(mo)活(huo)檢(jian)(jian)是診(zhen)斷(duan)結(jie)(jie)核性(xing)胸(xiong)(xiong)(xiong)膜(mo)(mo)(mo)炎的重要手段。活(huo)檢(jian)(jian)的胸(xiong)(xiong)(xiong)膜(mo)(mo)(mo)組(zu)織除了(le)可行病(bing)(bing)理檢(jian)(jian)查(cha)外(wai)，還可行結(jie)(jie)核菌的培養(yang)。如壁層胸(xiong)(xiong)(xiong)膜(mo)(mo)(mo)肉(rou)(rou)芽(ya)(ya)腫(zhong)改變(bian)提示結(jie)(jie)核性(xing)胸(xiong)(xiong)(xiong)膜(mo)(mo)(mo)炎的診(zhen)斷(duan)，雖(sui)然其他的疾病(bing)(bing)如真菌性(xing)疾病(bing)(bing)、結(jie)(jie)節病(bing)(bing)、土(tu)拉菌病(bing)(bing)（tuaremia）和風濕性(xing)胸(xiong)(xiong)(xiong)膜(mo)(mo)(mo)炎均可有肉(rou)(rou)芽(ya)(ya)腫(zhong)病(bing)(bing)變(bian)，但95%以上的胸(xiong)(xiong)(xiong)膜(mo)(mo)(mo)肉(rou)(rou)芽(ya)(ya)腫(zhong)病(bing)(bing)變(bian)系結(jie)(jie)核性(xing)胸(xiong)(xiong)(xiong)膜(mo)(mo)(mo)炎。如胸(xiong)(xiong)(xiong)膜(mo)(mo)(mo)活(huo)檢(jian)(jian)未能發現(xian)(xian)肉(rou)(rou)芽(ya)(ya)腫(zhong)病(bing)(bing)變(bian)，活(huo)檢(jian)(jian)標本(ben)應該做抗酸(suan)染色，因為(wei)(wei)偶然在標本(ben)中可發現(xian)(xian)結(jie)(jie)核桿菌。第(di)1次(ci)胸(xiong)(xiong)(xiong)膜(mo)(mo)(mo)活(huo)檢(jian)(jian)可發現(xian)(xian)60%的結(jie)(jie)核肉(rou)(rou)芽(ya)(ya)腫(zhong)改變(bian)，活(huo)檢(jian)(jian)3次(ci)則為(wei)(wei)80%左右。如活(huo)檢(jian)(jian)標本(ben)培養(yang)加(jia)上顯微鏡檢(jian)(jian)查(cha)，結(jie)(jie)核的診(zhen)斷(duan)陽性(xing)率為(wei)(wei)90%。也可用(yong)胸(xiong)(xiong)(xiong)腔(qiang)鏡行直視下胸(xiong)(xiong)(xiong)膜(mo)(mo)(mo)活(huo)檢(jian)(jian)，陽性(xing)率更高。

14.2X線檢查

胸腔(qiang)(qiang)積(ji)液(ye)在300ml以下(xia)時(shi)(shi)(shi)，后前(qian)位X線胸片(pian)可(ke)能無(wu)陽性發現。少量(liang)積(ji)液(ye)時(shi)(shi)(shi)肋膈角(jiao)變鈍，積(ji)液(ye)量(liang)多(duo)在500ml以上(shang)，仰(yang)臥位透視(shi)觀察，由(you)于(yu)積(ji)聚于(yu)胸腔(qiang)(qiang)下(xia)部(bu)的(de)液(ye)體散開，復見銳利(li)的(de)肋膈角(jiao)。也(ye)可(ke)患側(ce)(ce)(ce)臥位攝(she)片(pian)，可(ke)見肺外側(ce)(ce)(ce)密(mi)度增高的(de)條狀影。中等量(liang)積(ji)液(ye)表現為胸腔(qiang)(qiang)下(xia)部(bu)均(jun)勻(yun)的(de)密(mi)度增高陰影，膈影被(bei)遮蓋，積(ji)液(ye)呈(cheng)(cheng)上(shang)緣外側(ce)(ce)(ce)高，內側(ce)(ce)(ce)低(di)的(de)弧形(xing)陰影。大量(liang)胸腔(qiang)(qiang)積(ji)液(ye)時(shi)(shi)(shi)，肺野大部(bu)呈(cheng)(cheng)均(jun)勻(yun)濃密(mi)陰影，膈影被(bei)遮蓋，縱隔向健側(ce)(ce)(ce)移(yi)位。

干(gan)性(xing)胸(xiong)膜炎(yan)患側僅肋膈(ge)角(jiao)(jiao)變(bian)頓(dun)，滲出性(xing)胸(xiong)膜炎(yan)中等量以上(shang)積液(ye)(ye)可見大(da)片均勻致密影，其上(shang)緣呈從外(wai)上(shang)向(xiang)內(nei)下的弧形，肋膈(ge)角(jiao)(jiao)消失，膈(ge)影及心影不清。大(da)量積液(ye)(ye)時(shi)縱膈(ge)向(xiang)健側移位，肋間隙變(bian)寬，膈(ge)肌下降。

結核性胸腔積液有些可表現(xian)為特殊類型，常見(jian)的(de)有：

14.2.1（1）葉間積液

液體積聚(ju)于一個(ge)或多個(ge)葉間隙(xi)(xi)內。表現為(wei)邊緣銳利的梭形(xing)陰(yin)(yin)影或圓(yuan)形(xing)陰(yin)(yin)影，在(zai)側位胸片上顯示積液位置與葉間隙(xi)(xi)有關。

14.2.2（2）肺下積液

液體(ti)主(zhu)要積聚于(yu)肺(fei)(fei)底與膈(ge)肌之間(jian)，常與肋胸膜腔積液同時存在(zai)。直(zhi)立位時，表(biao)現(xian)為患側膈(ge)影(ying)增高，膈(ge)頂點由正常的內1/3處移到(dao)外1/3處，中部較平(ping)坦。左側肺(fei)(fei)底積液表(biao)現(xian)為膈(ge)影(ying)與胃(wei)泡之間(jian)的距離增大，患側肋膈(ge)角變鈍。如懷疑(yi)肺(fei)(fei)下積液，囑患者患側臥位20min后作胸透或(huo)胸片檢(jian)查，此時液體(ti)散開，患側肺(fei)(fei)外緣呈帶(dai)狀陰(yin)影(ying)，并(bing)顯出膈(ge)肌影(ying)。帶(dai)狀陰(yin)影(ying)越厚，積液越多。

14.2.3（3）包裹性積液

系胸膜粘連形成的(de)局限性胸腔積(ji)液。肋胸膜腔包裹性積(ji)液常發(fa)生于下(xia)部的(de)后(hou)外(wai)側壁(bi)，少數可發(fa)生在(zai)前胸壁(bi)。X線征象直立位或適當傾(qing)斜位時可顯示(shi)底邊貼(tie)附(fu)于胸壁(bi)，內(nei)緣向(xiang)肺(fei)野凸(tu)出的(de)邊界銳利、密度均(jun)勻的(de)梭形或橢圓形陰影，陰影邊緣與胸壁(bi)呈鈍角。

14.2.4（4）縱隔積液

系縱(zong)隔(ge)(ge)胸膜腔的(de)積液(ye)(ye)。前縱(zong)隔(ge)(ge)積液(ye)(ye)表現(xian)為沿(yan)心(xin)臟(zang)及大血管邊沿(yan)的(de)陰(yin)影(ying)，右前上(shang)(shang)縱(zong)隔(ge)(ge)積液(ye)(ye)陰(yin)影(ying)頗似(si)胸腺陰(yin)影(ying)或右上(shang)(shang)肺不張陰(yin)影(ying)。取右側臥(wo)位，左前斜30°位置20～30min后，攝該(gai) *** 的(de)后前位胸片，顯示(shi)上(shang)(shang)縱(zong)隔(ge)(ge)陰(yin)影(ying)明(ming)顯增寬。前下縱(zong)隔(ge)(ge)積液(ye)(ye)須與心(xin)臟(zang)增大陰(yin)影(ying)或心(xin)包積液(ye)(ye)相鑒(jian)別。后縱(zong)隔(ge)(ge)積液(ye)(ye)表現(xian)為沿(yan)脊柱的(de)三(san)角形或帶狀陰(yin)影(ying)。

14.3超聲波檢查

超聲探測胸(xiong)腔(qiang)積液的(de)靈敏度(du)(du)高，定位(wei)準(zhun)確，并可(ke)估計胸(xiong)腔(qiang)積液的(de)深度(du)(du)和積液量(liang)，提示(shi)胸(xiong)腔(qiang)穿刺部位(wei)。亦可(ke)以(yi)和胸(xiong)膜增厚進行鑒別。

15結核性胸膜炎的診斷

根據(ju)患(huan)者的(de)病史和臨(lin)床表現，結核性胸(xiong)(xiong)膜(mo)炎(yan)一般可(ke)確(que)診。臨(lin)床表現主要為中度發熱、初起胸(xiong)(xiong)痛(tong)以后減輕(qing)、呼吸困難。體(ti)格檢(jian)(jian)查、X線(xian)檢(jian)(jian)查及(ji)超聲波檢(jian)(jian)查可(ke)作出(chu)胸(xiong)(xiong)液的(de)診斷。診斷性胸(xiong)(xiong)腔(qiang)穿刺(ci)、胸(xiong)(xiong)液的(de)常規檢(jian)(jian)查、生化檢(jian)(jian)查和細(xi)菌培養等為診斷的(de)必(bi)要措(cuo)施(shi)，這些措(cuo)施(shi)可(ke)對75%的(de)胸(xiong)(xiong)液病因(yin)作出(chu)診斷。

16鑒別診斷

干性胸(xiong)膜(mo)炎應(ying)與肋間神經痛、流行(xing)性肌痛相鑒別(bie)。滲(shen)出性胸(xiong)膜(mo)炎要(yao)與風濕性疾(ji)病(bing)和惡性腫瘤(liu)引(yin)起的胸(xiong)腔積液(ye)相鑒別(bie)。

結核性(xing)(xing)胸(xiong)膜炎(yan)須與細菌性(xing)(xing)肺炎(yan)和胸(xiong)膜炎(yan)，以及(ji)惡性(xing)(xing)胸(xiong)腔積(ji)液進行鑒(jian)別。

16.1細菌性肺炎

結(jie)核性胸(xiong)膜(mo)炎(yan)(yan)的急性期(qi)常(chang)有發熱、胸(xiong)痛、咳嗽、氣促，血白細胞(bao)增多(duo)，胸(xiong)片X線(xian)表現高密度均勻陰(yin)影，易(yi)誤診為(wei)肺(fei)炎(yan)(yan)。但(dan)肺(fei)炎(yan)(yan)時(shi)咳嗽多(duo)有痰(tan)，常(chang)呈鐵銹(xiu)色痰(tan)。肺(fei)部為(wei)實變(bian)體(ti)征，痰(tan)涂(tu)片或培養常(chang)可發現致病菌。結(jie)核性胸(xiong)膜(mo)炎(yan)(yan)則以干(gan)咳為(wei)主，胸(xiong)部為(wei)積(ji)液(ye)體(ti)征，PPD試(shi)驗(yan)可陽性。

16.2類肺炎性胸腔積液

類肺(fei)炎性胸腔積(ji)(ji)液發生于細(xi)菌性肺(fei)炎、肺(fei)膿腫和支氣管擴張伴有胸腔積(ji)(ji)液者，患(huan)者多(duo)有肺(fei)部病(bing)(bing)變的(de)病(bing)(bing)史，積(ji)(ji)液量不多(duo)，見于病(bing)(bing)變的(de)同側。胸液白細(xi)胞數明顯增多(duo)，以中性粒(li)細(xi)胞為主，胸液培養(yang)可(ke)有致病(bing)(bing)菌生長。

16.3惡性胸腔積液

肺(fei)部惡性(xing)(xing)(xing)腫(zhong)瘤(liu)、乳腺癌、淋巴瘤(liu)的胸膜直接侵犯或轉(zhuan)移、胸膜間(jian)皮瘤(liu)等均(jun)可產生胸腔積液，而以(yi)肺(fei)部腫(zhong)瘤(liu)伴發胸腔積液最為常見。結核性(xing)(xing)(xing)胸腔積液與(yu)(yu)腫(zhong)瘤(liu)性(xing)(xing)(xing)胸腔積液的鑒(jian)(jian)(jian)別要點見表1。結核性(xing)(xing)(xing)胸膜炎(yan)(yan)有時(shi)須(xu)與(yu)(yu)系統性(xing)(xing)(xing)紅斑狼瘡性(xing)(xing)(xing)胸膜炎(yan)(yan)、類風濕性(xing)(xing)(xing)胸膜炎(yan)(yan)等伴有胸腔積液者鑒(jian)(jian)(jian)別，這(zhe)些疾病(bing)均(jun)有各(ge)自(zi)的臨床特點，鑒(jian)(jian)(jian)別不難。

17結核性胸膜炎的治療

結核性胸(xiong)膜(mo)炎的治療(liao)包括一般治療(liao)、抽取胸(xiong)液和抗結核治療(liao)。其化療(liao)原則與化療(liao)方(fang)法(fa)和活動性結核相同。

17.1一般治療

體溫38℃以(yi)(yi)上可臥(wo)床休(xiu)息(xi)(xi)，一般結(jie)核性(xing)胸膜炎患者可以(yi)(yi)適(shi)當起床活(huo)動。總的休(xiu)息(xi)(xi)時間(jian)大約(yue)以(yi)(yi)體溫恢復正常(chang)，胸液消失后仍須持續2～3個(ge)月。

17.2胸腔穿刺抽液

由于結核性胸(xiong)(xiong)膜(mo)炎胸(xiong)(xiong)液(ye)(ye)(ye)蛋白(bai)含(han)量和纖維蛋白(bai)含(han)量高，容易引(yin)起胸(xiong)(xiong)膜(mo)粘連(lian)，故原則上(shang)應盡快(kuai)抽盡胸(xiong)(xiong)腔(qiang)(qiang)內(nei)積液(ye)(ye)(ye)，每(mei)周2～3次。首次抽液(ye)(ye)(ye)不要超過(guo)(guo)700ml，以后每(mei)次抽取量約1000ml，最多不要超過(guo)(guo)1500ml。如(ru)(ru)抽液(ye)(ye)(ye)過(guo)(guo)多、過(guo)(guo)快(kuai)，可由于胸(xiong)(xiong)腔(qiang)(qiang)內(nei)壓(ya)力驟降發(fa)生復張(zhang)后肺水腫和循環衰(shuai)竭(jie)。若出(chu)現頭暈、出(chu)汗、面色(se)蒼白(bai)、脈搏細(xi)弱(ruo)、四(si)肢發(fa)冷(leng)、血壓(ya)下(xia)(xia)降等(deng)反(fan)應，立即停止(zhi)抽液(ye)(ye)(ye)，皮下(xia)(xia)注射0.5%腎上(shang)腺素0.5ml，同時靜脈內(nei)注射地(di)塞米(mi)松5～10mg，保留靜脈輸(shu)液(ye)(ye)(ye)導管，直至癥狀消失。如(ru)(ru)發(fa)生肺復張(zhang)后肺水腫，應進行相應的(de)搶(qiang)救。

胸腔抽(chou)液(ye)有以(yi)下(xia)作用：

①減(jian)輕中(zhong)毒(du)癥狀，加速退熱。

②解除(chu)肺臟(zang)和心臟(zang)血管(guan)受壓，改善呼(hu)吸及循環(huan)功能。

③防止纖維蛋白沉著所致(zhi)胸膜粘(zhan)連肥厚。目前也有學者主張早期大量(liang)抽液(ye)或胸腔插(cha)管引流可(ke)減少(shao)胸膜增厚和胸膜粘(zhan)連等并發癥。

17.3抗結核藥物治療

一般采用(yong)鏈霉(mei)(mei)素（SM）、異(yi)煙肼(jing)（INH）和利福平（RFP）或鏈霉(mei)(mei)素（SM）、異(yi)煙肼(jing)（INH）、乙胺(an)(an)丁醇（EMB）聯合治(zhi)療結核(he)性(xing)胸膜炎。鏈霉(mei)(mei)素（SM）0.75～1.0g/d，肌內(nei)注射(she)，療程2～3個月(yue)。異(yi)煙肼(jing)（INH）0.3g/d，頓服(fu)(fu)，利福平（RFP） 0.45～0.6g/d，頓服(fu)(fu)，乙胺(an)(an)丁醇（EMB） 0.75g/d，頓服(fu)(fu)，上述口服(fu)(fu)藥物(wu)(wu)均連續服(fu)(fu)用(yong)1.0～1.5年。治(zhi)療過程必須注意抗(kang)結核(he)藥物(wu)(wu)的(de)副(fu)作(zuo)用(yong)，如(ru)聽(ting)力的(de)變化(hua)、視(shi)覺的(de)變化(hua)和肝功能等，發生時(shi)應根(gen)據(ju)情況(kuang)減量或停用(yong)。

結(jie)核性胸(xiong)(xiong)膜炎不主張常規使用糖皮質激素，因為有(you)許多副作用。當(dang)大(da)量胸(xiong)(xiong)腔積液、吸收不滿意或結(jie)核中毒癥(zheng)狀(zhuang)(zhuang)嚴重時(shi)可用潑(po)尼松30mg/d，至胸(xiong)(xiong)液明(ming)顯(xian)減(jian)(jian)少(shao)或中毒癥(zheng)狀(zhuang)(zhuang)減(jian)(jian)輕時(shi)每周減(jian)(jian)少(shao)5～10mg，一般4～6周停(ting)藥。減(jian)(jian)藥太快或用藥時(shi)間(jian)太短(duan)，容易產(chan)生胸(xiong)(xiong)液或毒性癥(zheng)狀(zhuang)(zhuang)的(de)反跳。

胸腔內注射抗結核藥(yao)(yao)物或皮質(zhi)激素沒有肯定意義。抗結核藥(yao)(yao)物在胸液的濃度已經足夠，胸腔內注射藥(yao)(yao)物對胸液的吸收及預(yu)防胸膜增厚(hou)與不用藥(yao)(yao)物者(zhe)沒有顯著(zhu)差異。

18預后

對結核性(xing)胸膜炎(yan)進(jin)行(xing)及時正確的治(zhi)療，預(yu)后多良好(hao)，如病程(cheng)遷延常至胸膜粘連、包裹，造成營養不良等，影(ying)響預(yu)后。

19結核性胸膜炎的預防19.1控制傳染源，減少傳染機會

結(jie)核(he)(he)菌(jun)涂片陽性病人是結(jie)核(he)(he)主要傳染(ran)源，早期(qi)發(fa)(fa)現(xian)和(he)合理治療涂片陽性結(jie)核(he)(he)病人，是預防結(jie)核(he)(he)病的根(gen)本措施(shi)。嬰幼兒患(huan)活動性結(jie)核(he)(he)，其家庭成員(yuan)應作(zuo)詳細檢查（攝(she)胸(xiong)片、PPD等）。對小學和(he)托(tuo)幼機構工作(zuo)人員(yuan)應定期(qi)體(ti)檢，及時發(fa)(fa)現(xian)和(he)隔離傳染(ran)源，能有效地減少感染(ran)結(jie)核(he)(he)的機會。

19.2普及卡介苗接種

實(shi)踐證明，接種(zhong)卡(ka)(ka)介(jie)(jie)苗(miao)(miao)(miao)(miao)是預防小兒結核病的(de)有效措施。卡(ka)(ka)介(jie)(jie)苗(miao)(miao)(miao)(miao)為(wei)法(fa)國醫師(shi)Calmette和(he)Guerin在(zai)1921年所發明，故又稱B.C.G，我國規定在(zai)新(xin)生兒期接種(zhong)卡(ka)(ka)介(jie)(jie)苗(miao)(miao)(miao)(miao)，按(an)規定卡(ka)(ka)介(jie)(jie)苗(miao)(miao)(miao)(miao)接種(zhong)于左上臂三角肌上端，皮內注射，劑(ji)量為(wei)0.05mg/次。劃(hua)痕法(fa)現已很少采用(yong)。衛生部1997年通知(zhi)取消7歲和(he)12歲的(de)卡(ka)(ka)介(jie)(jie)苗(miao)(miao)(miao)(miao)復種(zhong)計(ji)劃(hua)。但必要時(shi)，對該年齡(ling)結素試驗陰性兒童仍可給予復種(zhong)。新(xin)生兒期卡(ka)(ka)介(jie)(jie)苗(miao)(miao)(miao)(miao)可與乙肝(gan)疫苗(miao)(miao)(miao)(miao)分(fen)手臂同天(tian)注射。

接(jie)種卡介苗(miao)禁忌(ji)證：陽性結素反應(ying)；濕疹或皮(pi)膚病患者；急性傳染病恢復期（1個月）；先天性胸(xiong)腺(xian)發育(yu)不全癥或嚴(yan)重(zhong)聯合免疫缺(que)陷病患者。

19.3預防性化療

主要用于下列對象(xiang)：

（1）3歲以下嬰幼兒未接(jie)種過卡介(jie)苗而結素(su)試驗陽(yang)性者。

（2）與開放性肺結(jie)核(he)病人(ren)（多(duo)系家庭成(cheng)員）密切(qie)接觸者。

（3）結素試(shi)驗新近(jin)由陰(yin)性(xing)轉為陽(yang)性(xing)者(zhe)。

（4）結素試驗呈強陽性反應者。

（5）結素(su)試驗陽性需(xu)較長期使(shi)用腎上(shang)腺(xian)皮(pi)質激(ji)素(su)或其他免疫抑制劑者。

20相關藥品

苯酚、葡萄糖(tang)、腺(xian)苷、干(gan)擾素、腎上(shang)腺(xian)素、地塞米松、鏈霉素、異煙肼、利(li)福平(ping)、乙胺(an)丁醇、潑尼松

21相關檢查

白(bai)細(xi)胞計數、紅細(xi)胞沉(chen)降率(lv)、干擾素

結核性胸膜炎相關藥物 氫化可的松注射液

2023-07-31 19:19:35

1、結核性胸膜炎一般急性起病，癥狀輕重不一。有全身中毒癥狀發熱、盜汗、乏力、胃納差等全身不適，胸痛、干咳以及咳嗽、局部針刺樣胸痛等。

2、結核性胸膜炎患者早期主要為輕中度發熱、刺激性咳嗽和胸痛。疼痛與呼吸有關，于深呼吸或咳嗽加重時，暫停呼吸可減輕，患者被迫淺呼吸以減輕疼痛。多發生于胸廓擴張度最大的部位，如腋側胸下部及季肋部。累及膈胸膜時，可放射至頸、肩或上腹部。疼痛的程度不一，其性質視患者的痛閾和個體差異而定。疼痛性質多為劇烈尖銳的針刺樣疼痛，于深呼吸時加重。淺吸氣、平臥或向患側臥位，胸廓的擴張度減低，胸痛可減輕。

3、結核性胸膜炎患者隨著病情進一步發展，胸痛減輕，但胸悶、氣急進行性加重，嚴重者呈端坐呼吸。

4、結核(he)性胸膜炎患者(zhe)胸腔積(ji)液(ye)(ye)增多時(shi)可有氣促、心悸，而局部(bu)胸痛可減(jian)(jian)輕或消失(shi)。少量(liang)積(ji)液(ye)(ye)時(shi)無明(ming)顯(xian)體征，中或大量(liang)積(ji)液(ye)(ye)時(shi)，患側(ce)呼(hu)吸運(yun)動減(jian)(jian)弱、語顫消失(shi)，叩診呈濁音(yin)或實(shi)音(yin)，呼(hu)吸音(yin)減(jian)(jian)弱或消失(shi)，氣管、縱膈(ge)均可移向(xiang)健(jian)側(ce)。

2023-07-31 18:18:25

胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)是(shi)各(ge)(ge)(ge)(ge)種原(yuan)因引起的(de)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)壁層(ceng)和(he)(he)臟(zang)層(ceng)的(de)炎(yan)(yan)(yan)(yan)癥(zheng)(zheng)。大(da)多(duo)(duo)(duo)為(wei)(wei)(wei)(wei)繼發(fa)(fa)(fa)(fa)于(yu)(yu)肺(fei)(fei)(fei)(fei)部(bu)和(he)(he)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)部(bu)的(de)病(bing)(bing)(bing)(bing)(bing)變(bian)(bian)，也可(ke)(ke)為(wei)(wei)(wei)(wei)全(quan)身(shen)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)疾(ji)病(bing)(bing)(bing)(bing)(bing)的(de)局部(bu)表(biao)(biao)(biao)(biao)現(xian)(xian)(xian)。臨(lin)(lin)床(chuang)(chuang)上胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)有(you)(you)(you)多(duo)(duo)(duo)種類型，以(yi)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)最為(wei)(wei)(wei)(wei)常見(jian)(jian)。本病(bing)(bing)(bing)(bing)(bing)屬中(zhong)醫(yi)“咳(ke)嗽、懸飲(yin)、肋痛(tong)(tong)(tong)”范(fan)(fan)疇。 1）臨(lin)(lin)床(chuang)(chuang)表(biao)(biao)(biao)(biao)現(xian)(xian)(xian) 1．病(bing)(bing)(bing)(bing)(bing)情輕者(zhe)無(wu)癥(zheng)(zheng)狀(zhuang)。 2．主(zhu)(zhu)要(yao)(yao)臨(lin)(lin)床(chuang)(chuang)表(biao)(biao)(biao)(biao)現(xian)(xian)(xian)為(wei)(wei)(wei)(wei)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)痛(tong)(tong)(tong)、咳(ke)嗽、胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)悶、氣(qi)急，甚(shen)則呼(hu)(hu)吸(xi)(xi)困難(nan)，感(gan)染(ran)(ran)(ran)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)或(huo)(huo)(huo)(huo)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔(qiang)積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye)繼發(fa)(fa)(fa)(fa)感(gan)染(ran)(ran)(ran)時，町有(you)(you)(you)惡寒(han)、發(fa)(fa)(fa)(fa)熱(re)。 3．不(bu)同病(bing)(bing)(bing)(bing)(bing)因所(suo)致(zhi)(zhi)(zhi)(zhi)的(de)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)可(ke)(ke)伴(ban)有(you)(you)(you)相(xiang)應(ying)(ying)(ying)疾(ji)病(bing)(bing)(bing)(bing)(bing)的(de)臨(lin)(lin)床(chuang)(chuang)表(biao)(biao)(biao)(biao)現(xian)(xian)(xian)。 2）診(zhen)斷檢(jian)查(cha)(cha) 1．一(yi)(yi)般(ban)分為(wei)(wei)(wei)(wei)以(yi)下十型： ① 纖(xian)(xian)維(wei)蛋白(bai)(bai)(bai)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)：即(ji)“干(gan)(gan)(gan)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)”，胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)局部(bu)滲(shen)出(chu)少(shao)(shao)量(liang)(liang)纖(xian)(xian)維(wei)蛋白(bai)(bai)(bai)而無(wu)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔(qiang)積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye)。多(duo)(duo)(duo)由(you)(you)肺(fei)(fei)(fei)(fei)部(bu)炎(yan)(yan)(yan)(yan)癥(zheng)(zheng)蔓延(yan)至(zhi)(zhi)(zhi)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)所(suo)致(zhi)(zhi)(zhi)(zhi)，多(duo)(duo)(duo)數無(wu)癥(zheng)(zheng)狀(zhuang)，少(shao)(shao)數病(bing)(bing)(bing)(bing)(bing)人有(you)(you)(you)局限性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)針(zhen)刺(ci)樣痛(tong)(tong)(tong)。 ② 漿液(ye)(ye)(ye)(ye)(ye)(ye)纖(xian)(xian)維(wei)蛋白(bai)(bai)(bai)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)：即(ji)“滲(shen)出(chu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)”，為(wei)(wei)(wei)(wei)漿液(ye)(ye)(ye)(ye)(ye)(ye)和(he)(he)纖(xian)(xian)維(wei)蛋白(bai)(bai)(bai)滲(shen)出(chu)積(ji)(ji)(ji)聚于(yu)(yu)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔(qiang)內，常由(you)(you)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)、化膿(nong)(nong)(nong)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)、腫(zhong)瘤性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)所(suo)致(zhi)(zhi)(zhi)(zhi)。胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)痛(tong)(tong)(tong)氣(qi)急為(wei)(wei)(wei)(wei)主(zhu)(zhu)要(yao)(yao)表(biao)(biao)(biao)(biao)現(xian)(xian)(xian)。 ③ 結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)：由(you)(you)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)菌(jun)(jun)(jun)(jun)從原(yuan)發(fa)(fa)(fa)(fa)綜(zong)合征的(de)淋(lin)巴(ba)結(jie)(jie)(jie)(jie)經淋(lin)巴(ba)管到達胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)，或(huo)(huo)(huo)(huo)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)下的(de)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)病(bing)(bing)(bing)(bing)(bing)灶(zao)蔓延(yan)至(zhi)(zhi)(zhi)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)所(suo)致(zhi)(zhi)(zhi)(zhi)。臨(lin)(lin)床(chuang)(chuang)主(zhu)(zhu)要(yao)(yao)有(you)(you)(you)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)干(gan)(gan)(gan)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)、結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)滲(shen)出(chu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)、結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)膿(nong)(nong)(nong)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)。常有(you)(you)(you)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)痛(tong)(tong)(tong)，氣(qi)急及(ji)(ji)(ji)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)中(zhong)毒癥(zheng)(zheng)狀(zhuang)。 ④ 腫(zhong)瘤性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)；由(you)(you)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)內或(huo)(huo)(huo)(huo)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)外(wai)癌腫(zhong)，直(zhi)接侵犯(fan)或(huo)(huo)(huo)(huo)轉移至(zhi)(zhi)(zhi)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)所(suo)致(zhi)(zhi)(zhi)(zhi)。主(zhu)(zhu)要(yao)(yao)表(biao)(biao)(biao)(biao)現(xian)(xian)(xian)為(wei)(wei)(wei)(wei)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)悶、進(jin)行性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)呼(hu)(hu)吸(xi)(xi)困難(nan)，并伴(ban)原(yuan)發(fa)(fa)(fa)(fa)病(bing)(bing)(bing)(bing)(bing)灶(zao)的(de)相(xiang)應(ying)(ying)(ying)癥(zheng)(zheng)狀(zhuang)。 ⑤ 化膿(nong)(nong)(nong)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)：多(duo)(duo)(duo)由(you)(you)肺(fei)(fei)(fei)(fei)、食道、腹部(bu)感(gan)染(ran)(ran)(ran)等蔓延(yan)至(zhi)(zhi)(zhi)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)所(suo)致(zhi)(zhi)(zhi)(zhi)。表(biao)(biao)(biao)(biao)現(xian)(xian)(xian)為(wei)(wei)(wei)(wei)惡寒(han)、高(gao)熱(re)、胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)痛(tong)(tong)(tong)、咳(ke)嗽和(he)(he)咯吐(tu)膿(nong)(nong)(nong)痰(tan)。 ⑥ 真菌(jun)(jun)(jun)(jun)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)：多(duo)(duo)(duo)由(you)(you)放線菌(jun)(jun)(jun)(jun)、白(bai)(bai)(bai)色念(nian)球菌(jun)(jun)(jun)(jun)累及(ji)(ji)(ji)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)所(suo)致(zhi)(zhi)(zhi)(zhi)。 ⑦ 結(jie)(jie)(jie)(jie)締組(zu)織病(bing)(bing)(bing)(bing)(bing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)：常見(jian)(jian)于(yu)(yu)類風濕性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)關節炎(yan)(yan)(yan)(yan)及(ji)(ji)(ji)系統(tong)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)紅(hong)(hong)斑狼瘡等疾(ji)病(bing)(bing)(bing)(bing)(bing)。以(yi)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)痛(tong)(tong)(tong)、氣(qi)急及(ji)(ji)(ji)原(yuan)發(fa)(fa)(fa)(fa)疾(ji)病(bing)(bing)(bing)(bing)(bing)癥(zheng)(zheng)狀(zhuang)為(wei)(wei)(wei)(wei)主(zhu)(zhu)要(yao)(yao)表(biao)(biao)(biao)(biao)現(xian)(xian)(xian)。 ⑧ 膽固醇(chun)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)；為(wei)(wei)(wei)(wei)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)液(ye)(ye)(ye)(ye)(ye)(ye)中(zhong)含(han)(han)有(you)(you)(you)大(da)量(liang)(liang)的(de)游離膽固醇(chun)結(jie)(jie)(jie)(jie)晶(jing)，可(ke)(ke)能(neng)與(yu)脂肪代謝(xie)障礙(ai)有(you)(you)(you)關，臨(lin)(lin)床(chuang)(chuang)癥(zheng)(zheng)狀(zhuang)輕微。 ⑨ 乳(ru)(ru)糜胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)：為(wei)(wei)(wei)(wei)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)液(ye)(ye)(ye)(ye)(ye)(ye)中(zhong)含(han)(han)淋(lin)巴(ba)乳(ru)(ru)糜，多(duo)(duo)(duo)因腫(zhong)瘤、淋(lin)巴(ba)結(jie)(jie)(jie)(jie)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)、絲蟲病(bing)(bing)(bing)(bing)(bing)肉芽腫(zhong)壓迫或(huo)(huo)(huo)(huo)損傷胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)導(dao)管和(he)(he)乳(ru)(ru)糜池所(suo)致(zhi)(zhi)(zhi)(zhi)。胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)悶、氣(qi)急為(wei)(wei)(wei)(wei)主(zhu)(zhu)要(yao)(yao)表(biao)(biao)(biao)(biao)現(xian)(xian)(xian)。 ⑩ 血(xue)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)：是(shi)指明(ming)(ming)顯的(de)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔(qiang)內出(chu)血(xue)。是(shi)由(you)(you)于(yu)(yu)自發(fa)(fa)(fa)(fa)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)氣(qi)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)、含(han)(han)血(xue)管的(de)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)黏連(lian)(lian)撕裂、或(huo)(huo)(huo)(huo)出(chu)血(xue)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胰腺炎(yan)(yan)(yan)(yan)等病(bing)(bing)(bing)(bing)(bing)因所(suo)致(zhi)(zhi)(zhi)(zhi)。主(zhu)(zhu)要(yao)(yao)表(biao)(biao)(biao)(biao)現(xian)(xian)(xian)為(wei)(wei)(wei)(wei)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)痛(tong)(tong)(tong)、胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)悶、甚(shen)至(zhi)(zhi)(zhi)休克(ke)(ke)(ke)等癥(zheng)(zheng)狀(zhuang)。 2．查(cha)(cha)體：干(gan)(gan)(gan)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)：呼(hu)(hu)吸(xi)(xi)運(yun)動(dong)受限，局部(bu)壓痛(tong)(tong)(tong)，呼(hu)(hu)吸(xi)(xi)音減(jian)弱(ruo)，可(ke)(ke)聞及(ji)(ji)(ji)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)摩擦音。滲(shen)出(chu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)：積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye)量(liang)(liang)多(duo)(duo)(duo)時患側呼(hu)(hu)吸(xi)(xi)運(yun)動(dong)受限，甚(shen)則強迫體位(wei)，呼(hu)(hu)吸(xi)(xi)急促，心率加快，胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)廓飽滿(man)，氣(qi)管向健側移位(wei)，叩診(zhen)呈實音，語顫(zhan)、呼(hu)(hu)吸(xi)(xi)減(jian)弱(ruo)或(huo)(huo)(huo)(huo)消(xiao)(xiao)失。 3．x線檢(jian)查(cha)(cha)：于(yu)(yu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)病(bing)(bing)(bing)(bing)(bing)變(bian)(bian)局限者(zhe)可(ke)(ke)無(wu)明(ming)(ming)顯變(bian)(bian)化。胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔(qiang)積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye)較(jiao)少(shao)(shao)時，見(jian)(jian)肋隔角模(mo)糊變(bian)(bian)鈍(dun)。胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔(qiang)積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye)較(jiao)多(duo)(duo)(duo)時，可(ke)(ke)見(jian)(jian)肺(fei)(fei)(fei)(fei)下野密度增加，陰影上緣自腋下向內下方(fang)呈弧形分布。 4．超(chao)聲波檢(jian)查(cha)(cha)：可(ke)(ke)發(fa)(fa)(fa)(fa)現(xian)(xian)(xian)透聲良好的(de)液(ye)(ye)(ye)(ye)(ye)(ye)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)暗區(qu)，可(ke)(ke)提示穿刺(ci)的(de)范(fan)(fan)圍、部(bu)位(wei)、深度。 5．實驗(yan)室檢(jian)查(cha)(cha)： ① 胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔(qiang)積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye)常規(gui)(gui)、生化、培養可(ke)(ke)判斷積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye)的(de)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)質，及(ji)(ji)(ji)發(fa)(fa)(fa)(fa)現(xian)(xian)(xian)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)菌(jun)(jun)(jun)(jun)或(huo)(huo)(huo)(huo)其他致(zhi)(zhi)(zhi)(zhi)病(bing)(bing)(bing)(bing)(bing)菌(jun)(jun)(jun)(jun)。 ② 結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)菌(jun)(jun)(jun)(jun)素(su)試驗(yan)及(ji)(ji)(ji)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)桿(gan)菌(jun)(jun)(jun)(jun)抗體陽性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)有(you)(you)(you)助于(yu)(yu)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)的(de)診(zhen)斷。 ③ 血(xue)常規(gui)(gui)檢(jian)查(cha)(cha)白(bai)(bai)(bai)細(xi)胞計數可(ke)(ke)正(zheng)常或(huo)(huo)(huo)(huo)增高(gao)，血(xue)沉(chen)常加快。 6．本病(bing)(bing)(bing)(bing)(bing)應(ying)(ying)(ying)注(zhu)(zhu)意與(yu)支(zhi)氣(qi)管肺(fei)(fei)(fei)(fei)癌胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)轉移及(ji)(ji)(ji)肝、腎、心臟(zang)疾(ji)病(bing)(bing)(bing)(bing)(bing)所(suo)致(zhi)(zhi)(zhi)(zhi)的(de)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔(qiang)積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye)相(xiang)鑒(jian)別。 3）一(yi)(yi)般(ban)治(zhi)(zhi)療(liao) 1．西醫(yi)： ① 抗生素(su)治(zhi)(zhi)療(liao) A. 抗結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)藥物(wu)治(zhi)(zhi)療(liao)：適用(yong)(yong)于(yu)(yu)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)干(gan)(gan)(gan)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)或(huo)(huo)(huo)(huo)滲(shen)出(chu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)的(de)治(zhi)(zhi)療(liao)。異煙肼每(mei)(mei)日(ri)(ri)300毫(hao)克(ke)(ke)(ke)、或(huo)(huo)(huo)(huo)利福平(ping)每(mei)(mei)日(ri)(ri)壩(ba)毫(hao)克(ke)(ke)(ke)、或(huo)(huo)(huo)(huo)乙胺丁(ding)醇(chun)每(mei)(mei)日(ri)(ri)0.75--1克(ke)(ke)(ke)，一(yi)(yi)次(ci)頓服(fu)，連(lian)(lian)續服(fu)藥3個(ge)月。鏈霉素(su)每(mei)(mei)日(ri)(ri)0.75--1克(ke)(ke)(ke)，肌(ji)注(zhu)(zhu)，1--2月，與(yu)口(kou)服(fu)藥交替使用(yong)(yong)，總計療(liao)程(cheng)6--9月。 B. 非(fei)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)：應(ying)(ying)(ying)針(zhen)對(dui)原(yuan)發(fa)(fa)(fa)(fa)病(bing)(bing)(bing)(bing)(bing)(如感(gan)染(ran)(ran)(ran)、腫(zhong)瘤等)選擇(ze)相(xiang)應(ying)(ying)(ying)的(de)藥物(wu)治(zhi)(zhi)療(liao)。 C. 化膿(nong)(nong)(nong)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)或(huo)(huo)(huo)(huo)結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)膿(nong)(nong)(nong)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)伴(ban)感(gan)染(ran)(ran)(ran)者(zhe)：青霉素(su)C每(mei)(mei)日(ri)(ri)160--320萬單位(wei)，分4次(ci)肌(ji)注(zhu)(zhu)，并可(ke)(ke)于(yu)(yu)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔(qiang)內再加注(zhu)(zhu)807單位(wei)。 ② 緩解(jie)疼痛(tong)(tong)(tong)：口(kou)服(fu)阿司匹(pi)林0.6克(ke)(ke)(ke)或(huo)(huo)(huo)(huo)消(xiao)(xiao)炎(yan)(yan)(yan)(yan)痛(tong)(tong)(tong)50毫(hao)克(ke)(ke)(ke)，每(mei)(mei)日(ri)(ri)3次(ci)，或(huo)(huo)(huo)(huo)可(ke)(ke)待因15--30毫(hao)克(ke)(ke)(ke)，每(mei)(mei)日(ri)(ri)3次(ci)。 ③ 胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔(qiang)穿刺(ci)抽液(ye)(ye)(ye)(ye)(ye)(ye)：適用(yong)(yong)于(yu)(yu)滲(shen)出(chu)性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)炎(yan)(yan)(yan)(yan)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)腔(qiang)大(da)量(liang)(liang)積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye)，有(you)(you)(you)明(ming)(ming)顯呼(hu)(hu)吸(xi)(xi)困難(nan)，或(huo)(huo)(huo)(huo)積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye)久(jiu)治(zhi)(zhi)仍不(bu)吸(xi)(xi)收者(zhe)。每(mei)(mei)次(ci)抽液(ye)(ye)(ye)(ye)(ye)(ye)量(liang)(liang)不(bu)宜(yi)超(chao)過1000毫(hao)升，每(mei)(mei)周(zhou)2--3次(ci)。 ④ 激素(su)治(zhi)(zhi)療(liao)：與(yu)抗結(jie)(jie)(jie)(jie)核(he)(he)(he)(he)(he)藥物(wu)聯(lian)用(yong)(yong)，對(dui)消(xiao)(xiao)除全(quan)身(shen)毒性(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)(xing)癥(zheng)(zheng)狀(zhuang)，促進(jin)積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye)吸(xi)(xi)收，防止胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)膜(mo)(mo)(mo)(mo)(mo)增厚黏連(lian)(lian)，有(you)(you)(you)積(ji)(ji)(ji)極的(de)治(zhi)(zhi)療(liao)作用(yong)(yong)。可(ke)(ke)用(yong)(yong)強的(de)松15--30毫(hao)克(ke)(ke)(ke)，分3次(ci)口(kou)服(fu)，待全(quan)身(shen)癥(zheng)(zheng)狀(zhuang)改(gai)善，積(ji)(ji)(ji)液(ye)(ye)(ye)(ye)(ye)(ye)明(ming)(ming)顯吸(xi)(xi)收減(jian)少(shao)(shao)時，可(ke)(ke)逐(zhu)漸減(jian)量(liang)(liang)，一(yi)(yi)般(ban)用(yong)(yong)藥4--6周(zhou)。 2．中(zhong)醫(yi)： ① 邪犯(fan)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)肺(fei)(fei)(fei)(fei)：惡寒(han)發(fa)(fa)(fa)(fa)熱(re)，咳(ke)嗽痰(tan)少(shao)(shao)，胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)脅刺(ci)痛(tong)(tong)(tong)，口(kou)苦咽干(gan)(gan)(gan)，舌紅(hong)(hong)苔薄，脈(mo)弦(xian)數。 取(qu)瓜(gua)(gua)蔞、貓瓜(gua)(gua)草各(ge)(ge)(ge)(ge)30克(ke)(ke)(ke)，柴胡(hu)、赤(chi)白(bai)(bai)(bai)芍各(ge)(ge)(ge)(ge)15克(ke)(ke)(ke)，黃芩(qin)、半夏、枳殼(ke)、桔梗、桑(sang)白(bai)(bai)(bai)皮各(ge)(ge)(ge)(ge)10克(ke)(ke)(ke)，甘草6克(ke)(ke)(ke)。 本方(fang)和(he)(he)解(jie)清(qing)熱(re)，理氣(qi)通(tong)絡(luo)。 ② 飲(yin)停胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)脅：咳(ke)唾引痛(tong)(tong)(tong)，呼(hu)(hu)吸(xi)(xi)困難(nan)，咳(ke)逆喘息不(bu)能(neng)乎臥，舌苔白(bai)(bai)(bai)膩，脈(mo)沉(chen)弦(xian)。 用(yong)(yong)百部(bu)30克(ke)(ke)(ke)，瓜(gua)(gua)萎、茯苓(ling)各(ge)(ge)(ge)(ge)15克(ke)(ke)(ke)，葶藶子11克(ke)(ke)(ke)，桑(sang)白(bai)(bai)(bai)皮、蘇于(yu)(yu)、陳(chen)皮、半夏、椒目、薤白(bai)(bai)(bai)、橘紅(hong)(hong)各(ge)(ge)(ge)(ge)10克(ke)(ke)(ke)，甘草6克(ke)(ke)(ke)。 本方(fang)逐(zhu)水祛飲(yin)。 ③ 痰(tan)淤互(hu)結(jie)(jie)(jie)(jie)：胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)痛(tong)(tong)(tong)胸(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)(xiong)悶，呼(hu)(hu)吸(xi)(xi)不(bu)暢，遷延(yan)經久(jiu)不(bu)已，舌紫暗、苔白(bai)(bai)(bai)，脈(mo)弦(xian)。 取(qu)意苡仁(ren)30克(ke)(ke)(ke)，瓜(gua)(gua)蔞、赤(chi)芍、茯苓(ling)各(ge)(ge)(ge)(ge)15克(ke)(ke)(ke)，旋復花、蘇于(yu)(yu)、杏仁(ren)、半夏、香附、陳(chen)皮、枳殼(ke)、路路通(tong)各(ge)(ge)(ge)(ge)10克(ke)(ke)(ke)，制乳(ru)(ru)沒(mei)各(ge)(ge)(ge)(ge)6克(ke)(ke)(ke)(包(bao)煎)。 本方(fang)化痰(tan)活血(xue)，理氣(qi)和(he)(he)絡(luo)。 ④ 陰虛內熱(re)：嗆咳(ke)少(shao)(shao)痰(tan)，口(kou)干(gan)(gan)(gan)咽燥，潮熱(re)盜汗，五心煩熱(re)，顴紅(hong)(hong)，形體消(xiao)(xiao)瘦，舌紅(hong)(hong)少(shao)(shao)苔，脈(mo)細(xi)數。 用(yong)(yong)沙參(can)、麥(mai)冬、玉竹、花粉(fen)、百部(bu)各(ge)(ge)(ge)(ge)15克(ke)(ke)(ke)，太(tai)子參(can)13克(ke)(ke)(ke)，桑(sang)白(bai)(bai)(bai)皮、地(di)(di)骨(gu)皮、功勞葉(xie)、銀柴胡(hu)、廣(guang)郁金、杏仁(ren)各(ge)(ge)(ge)(ge)10克(ke)(ke)(ke)，川貝粉(fen)6克(ke)(ke)(ke)(沖(chong)服(fu))。 本方(fang)滋陰清(qing)熱(re)。 4）預防調(diao)養 l. 注(zhu)(zhu)意休息，高(gao)蛋白(bai)(bai)(bai)及(ji)(ji)(ji)高(gao)維(wei)生素(su)飲(yin)食。 2. 治(zhi)(zhi)療(liao)應(ying)(ying)(ying)堅持、徹(che)底(di)。 愛心提示：以(yi)上介紹用(yong)(yong)方(fang)，請務必(bi)咨(zi)詢當地(di)(di)正(zheng)規(gui)(gui)中(zhong)醫(yi)醫(yi)院，結(jie)(jie)(jie)(jie)合自身(shen)生理特點和(he)(he)不(bu)同的(de)病(bing)(bing)(bing)(bing)(bing)理變(bian)(bian)化，辨(bian)證選擇(ze)使用(yong)(yong)。 以(yi)上回答如果滿(man)意，請不(bu)要(yao)(yao)辜負(fu)我的(de)一(yi)(yi)片好意，及(ji)(ji)(ji)時采納為(wei)(wei)(wei)(wei)答案。